NPI | 1003556515 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: CA A191221) |
Additional Taxonomies | 208000000X Pediatrics (Licence: MA 293781) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2022-03-31 |
Last Update Date | 2024-04-12 |